Tricky Diagnosis Do Programs Save Money

Congress is lukewarm about the ability of disease management to curb Medicare costs.

Disease management programs, ranging from telephone reminders to quit smoking to home visits to assist high-risk pregnant women, have been touted as a home run for public health and corporate bean counters alike.

And new programs like Blue Cross and Blue Shield of North Carolina’s obesity initiative continue to be launched. In 2003, 58 percent of employers provided at least one such program, compared with 41 percent in 2002, according to a survey on employer-sponsored health plans conducted by Mercer Human Resource Consulting.

Still, the cost-savings question remains unanswered at best.

In October, the Congressional Budget Office was lukewarm about the ability of disease management to curb Medicare’s rising costs. Studies so far have primarily focused on medical outcomes, such as blood sugar readings in diabetics, the report’s authors wrote. When the numbers were crunched, not all of the relevant medical costs were included.

A study of Texas patients, reported at the American Heart Association’s annual meeting in November, found that a congestive heart failure education program extended patient survival by two months, but didn’t save any money.

"It made people feel better. But it did not keep them out of the hospital or the doctor’s office." says Dr. Autumn Dawn Galbreath, study author and director of the disease management center at the University of Texas Health Sciences Center in San Antonio

Galbreath is quick to acknowledge that her research, as well as the Congressional Budget Office analysis, involves older and generally sicker patients rather than the typical employee. Even so, she says, "people just need to be realistic in their anticipation of savings."

One problem is that disease management encompasses such a grab bag of programs that it’s difficult to draw any broad conclusions, says Kenneth Thorpe, chairman of the department of health policy and management at Emory University’s Rollins School of Public Health in Atlanta.

Rather than debunking the overall concept, energy should be focused on finding the most effective approach, Thorpe says. He recently completed a study showing that 27 percent of the nation’s ballooning health costs from 1987 to 2001 could be attributed to obesity.

Referring to the increasing pounds Americans are gaining, Thorpe says, "Right from the get-go, your workers are sicker than they were 20 years ago. If you are going to manage these chronic (health) conditions, you have to manage people’s behavior."

Cigna HealthCare’s efforts with diabetes patients are an example of a success story. Research published over the summer in the journal Health Affairs tracked the results of more than 43,000 members enrolled in the company’s diabetes disease management program from 1998 to 2001. When participants remained active in the program most of the first year, their average medical costs declined 8.1 percent from the previous year.

Even transient interest in the program appeared to have a demonstrable impact. Medical costs for all participants, including those involved just a month or two, declined 5.3 percent.